高频振荡通气治疗早产儿严重呼吸衰竭的效果  

The Effect of High Frequency Oscillatory Ventilation in the Treatment of Severe Respiratory Failure in Preterm Infant

作　　者：王模奎[1] 黄薇[1] 宗小敏[1] 苏华英[1] 杨介梅[1] 王琴[1] 吕勇彬[1] 卢婷[1] 

机构地区：[1]宜宾市第一人民医院,四川宜宾644000

出　　处：《中外医学研究》2016年第22期3-6,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:观察高频振荡通气(HFOV)对早产儿重度呼吸窘迫综合征(RDS)并严重呼吸衰竭的疗效,以期为临床治疗提供参考。方法:回顾2013年8月-2016年2月笔者所在医院NICU出院的30例早产儿重度呼吸窘迫综合征并严重呼吸衰竭的病例,均是在肺表面活性物质+常频机械通气治疗2h后吸入氧分数(FIO_2)≥80%,经皮氧饱和度(TcSO_2)≤85%,动脉血氧分压(PaO_2)<50mmHg和/或动脉血二氧化碳分压(PaCO_2)>55mmHg的情况下启用HFOV。观察HFOV治疗后0、2、24、48h的FIO_2、PaO_2、氧合指数(OI)、PaCO_2、平均气道压、振幅变化情况。结果:HFOV治疗2h后,所有参数即显著改善,其中FIO_2由(86.30±5.53)%降至(64.20±5.58)%,PaO_2由(44.70±2.65)mmHg升到(55.60±4.90)mmHg,OI由(34.60±3.76)降到(18.90±2.68),PaCO_2由(65.30±6.95)mmHg降到(50.40±7.12)mmHg(P<0.01)。所有参数在24h均持续改善(P<0.01);除PaCO_2外,所有参数在48h也持续改善(P<0.05)。HFOV治疗48h后存活28例,5例发生颅内出血,无气胸病例。结论:HFOV对肺表面活性物质+常频机械通气治疗失败的早产儿重度RDS并严重呼吸衰竭患儿有显著效果。Objective：To observe the effect of high frequency oscillatory ventilation（HFOV） on severe respiratory distress syndrome（RDS） and severe respiratory failure in preterm infants,and to provide reference for clinical treatment.Method：30 severe respiratory distress syndrome and severe respiratory failure in preterm infants with severe respiratory distress syndrome in our hospital from August 2013 to February 2016 were reviewed,in the case of inhaled oxygen fraction in pulmonary surfactant therapy＋conventional mechanical ventilation after treatment of 2 h fraction of inspiration O2（FIO2≥80%）,transcutaneous oxygen saturation（Tc SO2）≤85%,Pa O250 mm Hg or Pa CO255 mm Hg enable HFOV.FIO2,Pa O2,oxygenation index（OI）,Pa CO2,mean airway pressure and amplitude change were observed after HFOV treatment 0,2,24,48 h.Result：All the parameters were improved significantly after 2 hours of HFOV.Among them,FIO2 decreased from（86.30±5.53）% to（64.20±5.58）%,Pa O2 increased from（44.70±2.65）mm Hg to（55.60±4.90）mm Hg,OI decreased from（34.60±3.76） to（18.90±2.68）,Pa CO2 decreased from（65.30±6.95）mm Hg to（50.40±7.12）mm Hg（P〈0.01）.All the parameters continue improved after 24 h of HFOV（P〈0.01）,and after 48 h,all the parameters also continue improved except Pa CO2（P〈0.05）.There were 28 survivors,5 intraventricular hemorrhage cases and no pneumothorax after 48 h of HFOV.Conclusion：HFOV on pulmonary surfactant＋often frequency mechanical ventilation in the treatment of failure of premature severe RDS and severe respiratory failure patients have remarkable curative effect.

关 键 词：高频振荡通气 严重呼吸衰竭 早产儿 呼吸窘迫综合征 

分 类 号：R722.6[医药卫生—儿科]